In 2016, nearly half of maternal deaths (48%)1 and almost a third of perinatal deaths (31%)2 occurring in health facilities in Bungoma County were referred from another facility. The facility level maternal and perinatal death reviews in the County, supported by the Maternal and Newborn Initiative (MANI) project highlighted multiple problems with the referral system, including:
- Delays in the decision to refer clients
- Inappropriate treatment prior to referral or lack of efforts to try to stabilise clients before transit (e.g. Administering magnesium sulphate to clients experiencing pre-eclampsia)
- Referring facilities not calling ahead to enable referral facilities to prepare for receiving emergency cases
- Referring facilities not sending completed referral slips or client history
- Lack of (or delays in organising) ambulances, drivers, and/or fuel, especially at night
- Lack of a nurse or clinician to accompany clients in ambulance
- Emergency clients being dropped off alone at facility entrances.